Background Safe and effective analgesia following episiotomy repair reduces postpartum morbidity. Oral diclofenac has proven to be of benefit in pain control, however, there is a need for an alternative route with the same analgesic efficacy because of the common significant side effects on the gastrointestinal tract. Hence, this study compared the effectiveness of rectal diclofenac to oral diclofenac in the management of pain after episiotomy repair at LAUTECH Teaching Hospital, Osogbo. Methods A randomised trial was carried out among parturients that had vaginal delivery and episiotomy repair from May to October 2020. 82 parturients (41 in each arm) were randomised to either 50mg oral or 50mg rectal diclofenac 12hourly for 24 hours after episiotomy repair. Pain score and level of maternal satisfaction were assessed, degree of side effects was also measured. Chi-square and Student t-test were used to identify association. Results There was no significant difference between the randomised groups in any socio-demographic characteristics. Rectal diclofenac group had a lower pain score (Rectal, Mean + SD 3.15+1.35 versus Oral, 6.46 + 2.85 p-value <0.0001), less need for additional analgesia (36.6% oral versus 7.3% of rectal, p-value =0.001) and improved level of maternal satisfaction compared to oral route (68.3% in rectal versus 2.4% in oral). Conclusions Irrespective of any socio-demographic characteristics, rectal diclofenac is more effective, has a high degree of acceptability and maternal satisfaction than oral diclofenac following episiotomy repair.

Background: There is no ideal contraceptive method; therefore, likelihood of method choice shifts among clients from time to time. Aim: The aim of this study is to determine the most chosen modern contraceptive method, and the factors influencing that choice among clients attending a relatively new tertiary health institution in Southwestern Nigerian. Methods: A retrospective review of the case records of clients attending the family planning clinic of Ladoke Akintola University of Technology Teaching Hospital Ogbomoso, southwestern Nigeria, from January 2012 to December 2017. Results: Six hundred and twenty-nine clients accessed modern contraceptive methods during the study period. Their age ranged between 15 and 50 years with a mean of 33.0 ± 12.93. Most of the clients were married 616 (97.9%), had postsecondary education 405 (64.4%), and were of Christian faith 460 (73.1%). Progestogen-only injectable was the mostly chosen by the clients 228 (36.2%), and this is followed by intrauterine contraceptive device 186 (29.6%). Child spacing was the most common reason for contraception by the clients 357 (56.8%). Parity, postpartum contraception, previous contraceptive use, outcome of last delivery, mode of delivery of antecedent pregnancy, and educational status were all significantly associated with the mostly chosen method. Conclusion: Progestogen-only injectable contraceptive is the mostly chosen method among the clients, and this is a shift from what is obtained in southwestern Nigeria where intrauterine contraceptive device used to be the modern contraception method of choice.

Original Research Article Membrane sweeping is the insertion of the digit beyond the internal cervical os followed by circumferential passes of the digit causing separation of the membranes from the lower uterine segment. The study aimed to determine the effect of membrane sweeping in conjunction with induction of labour in a teaching hospital in south western Nigeria. It was a randomized controlled trial among pregnant women with valid indications for labour induction at term in Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital, Osogbo. Seventy-six women were randomised into "sweep" and "no-sweep" groups with 38 in each arm. The women were blinded to the groups and only the doctors who performed the initial vaginal examination knew the allocation. The outcome of induction of labour, induction to delivery interval, usage of Oxytocin for augmentation of labour, the pain scores, usage of analgesia and satisfaction level were determined between the two arms of the study. The collected data was analysed using Statistical package for Social Sciences (SPSS20) Software. Level of significance was set at <0.05.Seventy-six women were recruited for the study, 38 women had their membrane swept before commencement of induction while 38 women had only induction without membrane sweeping. No patient dropped out from the study. Swept women had higher spontaneous vaginal delivery rate (100% compared with 84.2%, p=0.011), shorter induction to delivery interval (mean 10hours compared with 14hours, p=0.001), fewer required oxytocin use (39.5%compared with 78.9%, p < 0.001) and less requirement for analgesia (31.6% compared 68.4%, p = 0.001) The study revealed that membrane sweeping at initiation of labour induction had significant effect on the spontaneous vaginal delivery rate, reduced oxytocic drug use, shortened induction to delivery interval and reduced usage of analgesia.

Introduction: Eclampsia has been one of the major causes of maternal mortality worldwide and its impacts are more felt in sub-Saharan Africa, including Nigeria. There is an urgent need to reduce its adverse effects on maternal health. The aim of this study is to reappraise our management protocol, identify gaps, and suggest ways of improvement.Methods and Materials: It is retrospective 10-year study of cases of eclampsia and assessing feto-maternal outcomes.Statistical Analysis: Categorical variables were summarized using frequency while continuous variables were summarized using mean and standard deviation. Measures of association were carried out using student t-test, F-test for continuous variables, and Chi-square test for categorical variables where appropriate. P value set at 0.05%.Results: 130 cases were identified. A comparative analysis was done on cases admitted to ICU and those managed without admission to ICU. Feto-maternal adverse effects were found more in cases admitted to ICU and were majorly unbooked cases.Conclusion: Despite ICU care, which should improve feto-maternal outcomes, the case in this study was opposite, suggesting suboptimal antenatal care, inefficient referral system, poor infrastructure, and inadequate manpower in our health sector. Sensitization will impact positively to reduce the burden of the disease.

Background: Norplant, a six-rod implant, was the first-generation subdermal contraceptive implant containing levonorgestrel. This had been replaced with the second-generation Implanon® and Jadelle®, which contain one rod and two rods, respectively. These second-generation implants have been shown to be as effective as the first-generation Norplant, but with less cumbersome insertion and removal techniques. The aim of this study is to evaluate the prevalence and use of subdermal contraceptive implants and the side effects among contraceptive method acceptors. Materials and Methods: A retrospective review of the case notes of clients who chose subdermal implants as a contraceptive method at Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso between 1 January 2014 and 31 December 2016. Mean and standard deviation were used to summarize continuous variables whereas frequency and percentage were used for categorical variables. Level of significance was set at a value of P < 0.05. Results: One hundred and forty-two clients made Implanon (115) and Jadelle (27) their contraceptive method of choice during the study period, accounting for 15.3% of the 928 contraceptive acceptors. Most of the acceptors were married (93.7%), and child spacing was mostly the reason for their choice (55.6%). The duration of the use of the method ranged between 6 and 49 months, and only 25 (17.6%) discontinued the method during the study period. The reason to discontinue the method was mostly to conceive (80%). Subdermal implants were well tolerated by the clients as 112 (78.9%) reported no unwanted side effects, and irregular vaginal bleeding was the most unwanted side effect in those that had them (59.3%). Conclusion: Subdermal implant contraceptives were well tolerated by the clients, and most clients did not report any side effects.

Background Worldwide heterosexual sex is the most common mode of HIV transmission, with the marital heterosexual route becoming a major contributor in sub-Sahara Africa. This study examined the role of inappropriate HIV status disclosure, after diagnosis, on marital sexual experiences of HIV positive women. Methods The study employed a descriptive cross-sectional design. An interviewer administered questionnaire that elicited information about HIV status disclosure to partners, sexual experiences, condom use and parity was administered to 122 married women living with HIV/AIDS. Participants were referred from peripheral health centres to receive comprehensive HIV care at the State Specialist Hospital, Osogbo, Nigeria. Results Mean age (SD) of respondents was 33.8 (8.9) years. Only 23.8% of partners had HIV screening, with 3.3% being HIV positive. A majority (62%) of respondents reported experiencing marital sex deprivation since their partners became aware of their HIV status. There was a reported rejection (74.3%) of condom use by partners during sexual intercourse. Fear of becoming infected (85.7%) and blaming the women for their positive status (85.7%) were the main reasons the respondents gave for being sexually deprived by their partners. Conclusion Inappropriate status disclosure due to poor HIV counseling and testing (HCT) practices resulted in sexual deprivation of married HIV positive women. Adequate training and retraining of health care workers on HCT and HIV status disclosure will reduce experience of sexual deprivation among married HIV positive women.

We assessed the prevalence and correlates of intimate partner violence (IPV) to women living with HIV/AIDS in an antiretroviral clinic in Nigeria. Three hundred sixty respondents were interviewed using a structured questionnaire. Sixty percent were married, of which 24% had disclosed HIV status to their partner. About a quarter (23.6%) had experienced IPV since HIV diagnosis. Types of violence experienced were physical violence (17%), emotional violence (21%), and sexual violence (2%). Predictors of IPV included having a younger aged partner, disclosing status, and partner’s alcohol use (p = .001). Suggestions to prevent IPV include increasing public awareness and family counseling.

Pre-eclampsia progressing to eclampsia is one of the major causes of maternal death in Nigeria. Since there is long term association of pre-eclampsia with cardiovascular disease, cerebrovascular disease, renal disease, short life expectancy and mortality, it is essential to obtain obstetric history for better counseling and long term monitoring. The study assessed the knowledge of health workers about the association of pre-eclampsia with future cardiovascular disease and offering any risk-reduction counseling to women with pre-eclampsia.

BACKGROUND:Nulliparity is an obstetric high-risk group whose labor, compared with multiparae, are more likely to develop labor abnormalities that requires intervention. The aim of this report is todetermine factors that influence vaginal delivery in nulliparae.MATERIALS AND METHODS:A prospective cross-sectional study was done on 286 eligible booked nulliparae in labor, to determine factors associated with vaginal delivery. Information about each patient's social demographic factors, and physical characteristics such as height and weight, events in labor and mode of delivery were recorded in the data sheet. Bivariate analysis was done using Chi square, while multivariate analysis was done using logistic regression. Level of significance was put at P < 0.05.RESULTS:Of a total of 944 primigravidae delivered in the unit during the study period, 286 (30.3%) were eligible for the study. Vaginal delivery was achieved in 214 (74.8%) of the eligible parturient, while 72 (25.2%) had emergency caesarean delivery. Indications for the caesarean delivery were: failure to progress (46; 63.9%), fetal distress (20; 27.8%), maternal distress (5; 8.0%), and rapidly developing pre-eclampsia in labor (1, 0.3%). The birth weight of the baby ranged between 2.0 and 4.5 kg with mean weight of 3.1 ± 0.4 kg. Birth weight (odd ratio [OR] = 0.40, 95% confidence interval [CI] = 0.21-0.78), fetal head engagement in early labor (OR = 10.30, 95% CI = 1.35-78.69), and maternal body mass index (BMI) (odd ratio [OR] = 2.08, 95% confidence interval [CI] = 1.03-4.20) were found to be predictors of vaginal delivery.CONCLUSION:Normal range of maternal BMI, fetal head engagement and normal range of fetal birth weight were found to be the factors associated with vaginal delivery in nulliparae. Variations in these three factors may be the underlying reason for failure to progress, which is the most common indication for caesarean section among this population of parturient.

Background: Pre-eclampsia complicates 2% - 8% of pregnancies. Various efforts have been put forward for its prevention and treatment. Magnesium sulphate is presently the recommended drug for the prevention and treatment of eclampsia and severe pre-eclampsia. Objectives: The study aimed to compare the serum magnesium in a healthy pregnant women and pre-eclamptic women. It determined demographic characteristic of the study population and recommended the prophylactic usage of magnesium sulphate in pregnancy in our environment. Method: This was a prospective case control study comparing the serum magnesium levels in pre-eclampsia and normal pregnancy tertiary hospitals. The women who satisfied the inclusion criteria were recruited in the two groups (seventy five in the healthy pregnant women and seventy five in the pre-eclamptic women). The blood samples were collected and analysed for the serum magnesium and urine sample for urinalysis. Result: Total of 150 patients comprises 75 normal pregnant women and 75 cases of pre-eclampsia. The mean serum magnesium in the normal pregnant women was 0.73 (±0.14) mmol/L while in preeclampsia the level was 0.58 (±0.17) mmol/L. This is statistically significant (t = 6.120, p = 0.000). There was significance difference in the mean age of patients with pre-eclampsia and normal pregnancy. The mean parity in the pre-eclampsia was 0.80 and in the normal pregnancy was 1.4 and was statistically significant (t = 3.40, p value

Background: Infection of mothers with Rubella virus during pregnancy can be serious; if the mother is infected within the first 20 weeks of pregnancy she is likely to have miscarriage, stillbirth, or baby with congenital rubella syndrome. This study was carried out to define Rubella virus seroprevalence in pregnancy in Osogbo, Nigeria. Methods: This study is a cross-sectional sero-survey of rubella IgG antibody among pregnant women attending antenatal clinic of Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria. Socio-demographic information on participants was collected by interviewer-administered questionnaire while venous samples were collected, stored at −20°C and serum samples were screened for detection of rubella IgG antibodies using the enzyme linked immunosorbent assay. Results: Of the 200 sample evaluated for rubella Immunoglobulin G antibody, 175 (87.5%) were positive and 25 (12.5%) were negative. The result indicated prevalence of 85.7% in 15-19 year age group, 86.8% in 20-24 year age group, 89.6% in 25-29 year group, and 100% in greater than 40 year age group. Rubella IgG seroprevalence was not associated with age, gestational age, gravidity, vaccination, occupation and education. Conclusions: As the immunity gap in the studied population was high, rubella vaccination should be provided for all women of child-bearing age and children

Vaginal infections in pregnancy are associated with considerable discomfort and adverse pregnancy outcomes including preterm delivery, low birth weight and increased infant mortality and also predisposition to HIV/AIDS. This study evaluated the prevalence and factors associated with vulvovaginal candidiasis, trichomoniasis and bacterial vaginosis among women attending antenatal clinic at a hospital in Nigeria. A semi-structured questionnaire was administered and high vaginal swab samples were obtained from consenting pregnant women. The samples were processed following standard protocols. The prevalence of vulvovaginal candidiasis was 36%, while those of trichomoniasis and bacterial vaginosis were 2% and 38%, respectively. Infections were higher in the third trimester and many women admitted to practices that increase risk of these infections. Significant association was found between recent intake of antibiotics and vaginal candidiasis, same association was also found with bacterial vaginosis. Adequate investigation and prompt treatment will reduce the morbidity and attendant effects of these prevalent infections on mother and fetus.

AIM AND OBJECTIVE:To determine changes in malondialdehyde (product of lipid peroxidation) and antioxidant enzymes (Superoxide Dismutase, Glutathione Per-oxidase) levels in pre-eclamptic Nigerian womenPATIENTS AND METHODS:A Total of 100 subjects each for pre-eclamptic,apparently normal and non pregnant women were recruited into the study.Venous blood samples were taken from the participants during second and third trimesters of pregnancy and at the point of contact for non pregnant women. Malondialdehyde, glutathione peroxidase and superoxide dismutase were measured accordingly from plasma and haemolysate prepared from whole blood.Variables were analysed using SPSS version 16, taking level of significance to be 0.05 RESULTS: Plasma malondialdehyde in the third trimester (3.13±0.61umol/l) of pre-eclamptic subjects was higher than in the second trimester (3.00±1.21umol/l).Plasma malondialdehyde in the third trimester of normal pregnancy (2.03±0.71umol/l) was also found to be significantly higher than in the second trimester (1.65±0.62umol/ l)(p<0.0001). Glutathione peroxidase in pre-eclamptic subjects was significantly higher in the third trimester (2804.11±1573.00U/L) as compared to the second trimester (2655.00±1751.30U/L), p= 0.0001.Glutathione peroxidase activity in the third trimester of normal pregnancy(3339.50±1733.80U/L) was also found to be higher than in the second trimester(3023.50±1115.90U/L)(p=0.131). Superoxide dismutase activity was significantly lower in the third trimester of pre-eclamptic pregnancy when compared to second trimester (110.40±59.47 Vs 118.01±64.41 U/ ml)(p<0.039) .Similarly,superoxide dismutase activity was significantly lower in the third trimester of normal pregnancy (110.40±59.47U/ml) than in the second trimester(153.01±71.85U/ml)(p<0.0001).CONCLUSION:There was an increased level of lipid peroxidation products,malondialdehyde in subjects with pre-eclampsia. This was more in the third trimester. There was an increased oxidative stress in pre-eclampsia as evidenced also by low serum level of superoxide dismutase in the third trimester.Diet rich in antioxidant enzyme might be beneficial.

Introduction: Caesarean section is one of the commonest surgical procedures worldwide. Its upward trend and associated morbidity/mortality especially in low-resource setting makes regular appraisal of the practice necessary. Methodology: A retrospective study. Labour ward logbook and case records were looked into, and all information extracted. Results: Caesarean section rate was 35.5%, with an upward trend. Perinatal death was still high. Main indication was previous caesarean section followed by obstructed labour while major maternal morbidity was wound sepsis. Identifiable factors to perinatal death were multiparity, emergency caesarean section and women that were referred to our health facility. Conclusion: Risk appraisal and all efforts must be geared towards reducing caesarean section rate especially in our environment where subsequent deliveries might not be attended to by skilled health personnel.

Background: The prevalence of contraceptive use has increased worldwide due to the development and introduction of modern contraceptives and the establishment of organized family planning programs. In Nigeria, there is a very slow rise in contraceptive use prevalence, resulting in high fertility rate. Generally contraceptive is either used for birth spacing, or for the purpose of terminal fertility control to limit the number of children, and the choice of method for this purpose varies. Aims and Objectives: To determine the contraceptive methods of choice among clients seeking terminal fertility control, and their reasons for the choice of such methods. Materials and Methods: A cross-sectional study of clients attending the family planning clinic of Ladoke Akintola University of Technology Teaching hospital over a period of twenty-four months, between July, 2009 and June, 2011. All clients who had completed their family, and wanted a contraceptive method to limit their family size filled the semi-structured questionnaire after giving their informed consent. Clients’ own reasons for the choice of the particular contraceptive method were grouped, entered into SPSS work sheet, and analyzed using SPSS version 17. Result: There were five hundred and ninety-two new contraceptive method acceptors during the study period, of which 264 (44.6%) were for terminal fertility control. Progestogen-only injectable contraceptive was the method of choice for terminal fertility control by 145 (54.9%) of the clients, while 85 (32.2%) made intrauterine contraceptive device (copper-T) their method of choice, and the least chosen method was female surgical sterilization (2, 0.8%). Ease of administration, satisfaction with previous use, long duration of action, and husband’s preference were the reasons for the choice of the methods. Conclusion: There is awareness of terminal fertility control in Nigeria, especially in the southwestern region of the country, and this may be responsible for the decreasing prevalence of grandmultiparity in the region. However, reversible contraceptive method is the preferred option for this purpose.

Background: Oxidative stress injury has been linked with some clinical conditions in newborn. This cannot be readily measured. Measuring placenta and birth weight along with other features may help in predicting likelihood of oxidative stress injury babies have suffered. Aim : to measure birth and placenta weight of new born babies as well as determining cord blood total antioxidant status and malondialdehyde (product of oxidant injury) Methods: Study site was labour ward of Ladoke Akintola University of Teachnology Teaching Hospital, Osogbo, Nigeria. Sixty four term newborn babies were recruited into the study. Plasma extracted from cord blood of subjects was used for the laboratory determination of total antioxidant status, malondialdehyde and uric acid. Total antioxidant status and malondialdehyde were measured using methods of Koracevic et al and Satoh et al respectively. Uric acid was measured by enzymatic method. Results: There were positive correlations between placenta weight and TAS(r=0.115;p>0.05), between placenta weight and Uric acid(r=0.075;p>0.05), between birth weight and TAS(r= 0.233,p=0.064), between birth weight and Uric acid(r=0.172;p>0.05). There were significant negative correlations between placenta weight and MDA(r=-0.25;p

BACKGROUND:Normal pregnancy has been associated with oxidative stress injury. Oxidative stress has been linked with poor perinatal outcome and birth asphyxia. The severity of this oxidative stress in newborn may be related to stress of different modes of delivery.METHODS:Eighty seven newborn babies were recruited in both labour ward and operating theatre of Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria. Fourty one of them was delivered via spontaneous vertex delivery, 26 via emergency caesarean section and the rest, 20 were delivered through elective caesarean section. Cord blood sample was collected from new born babies immediately after delivery. Plasma was extracted and used for the laboratory measurement of total antioxidant status, malondialdehyde and Uric acid.RESULTS:There were no significant (P>0.05) changes among the studied groups in mean plasma levels of malondialdehyde, total antioxidant status and uric acid. However, a trend was observed in these parameters. Mean plasma total antioxidant status/mmol/l was observed to be highest in subjects delivered through ECS (2.35 ± 0.05) and lowest in subjects delivered through SVD (2.03 ± 0.08). Similarly mean plasma UA/mg/dl was also observed to be highest in subjects delivered through ECS (3.61 ± 0.16) lowest in those delivered through SVD (3.49 ± 0.71). The highest mean plasma level of MDA/µmol/l was found in subjects delivered through SVD (5.78 ± 1.56) while the lowest was found in subjects delivered through ECS (5.01 ± 1.21).CONCLUSION:There is no significant relationship between oxidative stress markers in neonate and the mode of delivery.

Eclampsia is one of the leading causes of maternal and perinatal morbidity and mortality in sub-Saharan Africa. This problem has continued unabated due to lack of policies supporting financial protection in times of ill health, non-implementation of proven interventions as well as gaps in capacity building by stakeholders in health care delivery in this region. The aim of this retrospective study is to assess the impact of eclampsia on maternal and perinatal survival and suggest ways of reducing maternal death. A 6-year retrospective study was conducted with eighty-three cases of eclampsia. The cases were mainly antepartum patients with poor blood pressure control and resultant eclampsia. The case fatality rate was 8.3% and perinatal death was 24.1%. Magnesiun sulphate may have contributed to improvements in pregnancy outcome as mortality was higher among women with no access to magnesium sulphate. Most of the eclamptic patients were referred late from private health facilities hence the need for public-private collaboration in strengthening the referral system and making magnesium sulphate widely available in maternal care centers.

BACKGROUNDProgestogen-only injectable contraceptive is a long-acting contraceptive given intramuscularly to give protection against unwanted pregnancy for a period of 2 or 3 months, depending on the type. Alterations in menstrual pattern are a well known side effect of this effective contraceptive method.OBJECTIVESTo determine the characteristics of women accepting the method, complications and indications for discontinuation.MATERIALS AND METHODSThis was a retrospective review of clients using progestogen-only injectable contraceptive between 1 st January, 2001 and 31 st December, 2009. Relevant information extracted from the case notes was analyzed. Survival analysis was carried out using Log-Rank Chi-square test to measure association over 12-month period of usage. Level of significance was set at P value less than 0.05.RESULTSA total of 1,967 women used contraception during the study period and 433 (22.1%) made progestogen-only injectable their method of choice. 199(45.96%) used NET-EN, while DMPA was used by234 (54.04%) women. Many of the women (197, 45.5%) used the method for terminal fertility control. Menstrual abnormality was the commonest (264, 71.4%) complaint about progestogen-only injectable contraceptive, of which amenorrhea was experienced by constituted 176(66.7%). Eighty-three (22.4%) women had discontinued the contraceptive, and menstrual abnormality was the commonest reason for the discontinuation (68, 81.9%). No pregnancy was reported among the women that came for follow up while on the method.CONCLUSIONShort duration of POIC use that is within 12 months is still high. However the main reason for discontinuation was found to be due to menstrual irregularities, hence the need for effective education of the women about this side effect, thus increasing the acceptance and continuation rate of the contraceptive method.